SUTURE MATERIALS AND TECHNIQUES

The Ideal Suture Material
• Can be used in any tissue • Easy to handle • Good knot security • Minimal tissue reaction

The Ideal Suture Material
• Unfriendly to bacteria
• Strong yet small • Won’t tear through tissues • Cheap

What’s It Used for?
• To bring tissue edges together and speed
wound healing (=tissue apposition)

• Orthopedic surgery to help stabilize joints
– Repair ligaments

• Ligate vessels or tissues

Types of Needles
• Eyed needles
– More Traumatic – Only thread through once – Suture on a reel – Tends to unthread itself easily

Types of Needles
• Swaged-on
needles
– Much less traumatic – More expensive suture material – Sterile

Points of Needles
• Taper
– Atraumatic – Internal organs

Points of Needles
• Cutting

• Cutting edge on
inside of circle

• Skin • Traumatic

Points of Needles
• Reverse Cutting
• Cutting edge on
outside of circle

• Skin • Less traumatic
than cutting

Cutting vs Reverse Cutting
• Cutting

• Reverse
cutting

Shapes of Needles
• • • •
3/8 circle 1/2 circle Straight Specialty

Characteristics of Suture Material
• Absorbable Vs. Nonabsorbable • Monofilament Vs. Multifilament

• Natural or Synthetic

Absorbable Sutures
• Internal • Intradermal/ subcuticular • Rarely on skin

Non-absorbable Suture
• Primarily Skin
– Needs to be removed later

• Stainless steel = exception
– Can be used internally • Ligature • Orthopedics – Can be left in place for long periods

Reading the Suture Label
Size Order Code Also: LENGTH NEEDLE SYMBOL Needle COLOR Absorbable or Non Name

• Company

Choosing Absorbable Vs. Nonabsorbable
• How long you need it
to work

• Do you want to see

the animal again for suture removal

Monofilament

Vs. Multifilament
easy to handle more tissue drag wicks/ bacteria good knot security +tissue reaction

• memory • less tissue drag • doesn’t wick • poor knot security • - tissue reaction

Natural Vs. Synthetic

• Natural:
– – – – Gut Chromic Gut Silk Collagen

• All are absorbable

Gut/ Chromic Gut
• Made of submucosa
of small intestines

• Multifilament • Breaks down by
phagocytosis: inflammatory reaction common

Gut/ Chromic Gut
• Chromic: tanned, lasts
longer, less reactive

• Easy handling • Plain: 3-5 days • Chromic: 10-15 days • Bacteria love this stuff!

Collagen and Silk
• Natural sutures
• VERY reactive,
absorbable

• Ophthalmic surgery
only

Vicryl (Polyglactin 910)
• Braided, synthetic, absorbable • Stronger than gut: retains strength 3

weeks • Broken down by enzymes, not phagocytosis • Break-down products inhibit bacterial growth
– Can use in contaminated wounds, unlike other multifilaments

Dexon and PGA
• Polymer of glycolic acids • Braided, synthetic, absorbable • Broken down by enzymes • Both PGA and dexon have increased tissue
drag, good knot security • Both are stronger than gut

PDS (polydioxine)
• Monofilament (less drag, worse knot
security – lots of “memory”) • Synthetic, absorbable • Very good tensile strength (better than gut, vicryl, dexon) which lasts months • Absorbed completely by 182 days

Maxon (polyglyconate)
• Monofilament- memory • Synthetic Absorbable • Very little tissue drag • Poor knot security • Very strong

NONABSORBABLE SUTURES
• Natural or Synthetic • Monofilament or multifilament

NYLON
• Synthetic • Mono or Multifilament • Memory • Very little tissue reaction • Poor knot security

Polymerized Caprolactum
• Vetafil, Braunamid, Supramid • Multifilament suture with protein coating • Synthetic • Good knot security, easy handling • Not very reactive • Don’t use in contaminated wound • Usually comes on a reel

Polypropylene
• Prolene, Surgilene • Monofilament, Synthetic • Won’t lose tensile strength over time • Good knot security • Very little tissue reaction

Stainless Steel
• Monofilament • Strongest ! • Great knot security • Difficult handling • Can cut through tissues • Very little tissue reaction, won’t harbor
bacteria

Suture Sizes
• Sized #5-4-3-2-1-0-00-000-0000…30-0
– BIGGER >>>>>>>>>>>>>>>>SMALLER

• 00 = 2-0, “two ought” • SA : 0 through 3-0 (Optho 5-0 >>7-0) • LA : 0 through 3

Suture Sizes (cont)
• Stainless Steel
– In gauges (like needles) • Smaller gauge = bigger, stronger • Larger gauge= smaller, finer – 26 gauge = “ought” – 28 gauge = 2-0

Skin Staples
• Very common in human medicine • Expensive • Very easy • Very secure • Very little tissue reaction • Removal =
– Special tool required

Tissue Adhesive
• Nexaband, Vetbond,
and others

• Little strength
• Should not be placed
between skin layers or inside body

Suture Patterns

Knot Strength
• Generally 4 “throws” for >90% knot
security (nylon may need 5)
– Less “throws” = more likely to untie itself

• Stainless steel = exception again
– 2 “throws” = 99% knot security

Simple Interrupted
Simple Interrupted Suture

Simple Continuous

Ford Interlocking

Subcuticular

Thank You !!

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